Abstract: An apparatus for supplying surgical buttress material to a surgical stapler is provided. The apparatus has a pivotable area for attaching surgical buttress material. The apparatus may also have an adhesive and a release liner disposed over the buttress material.

Abstract: A method and apparatus for surgically repairing a tear in soft tissue is disclosed. A plurality of collapsible tubes are positioned about the suture. The collapsible tubes are pushed through soft tissue and orthopedic mesh on opposite sides of a tear in soft tissue. When tension is applied to the suture, the tubes are compressed to fix the suture to the soft tissue and draw the soft tissue portions together.

Abstract: A drill guide and pin system is provided whereby a drill may be inserted through a drill sleeve into a bone portion to provide a drill bore. For some embodiments, a cooperating pin provides a pin bore which intersects the drill bore at a predetermined angle ? and predetermined location relative to at least one of the drill sleeve and/or bore. The pin may have an integral catch so that when a wire is inserted through the drill bore, the catch can pull the wire through the pin bore for use in various surgical techniques. Some embodiments have an articulated arm which can lock in a fixed position in a fixed configuration and have a moveable configuration as well.

Abstract: Apparatus and methods for rapid deployment of tissue anchors are described herein. A tissue manipulation assembly is pivotably coupled to the distal end of a tubular member and has a lower jaw member and an upper jaw member pivotably coupled to the lower jaw member. A reconfigurable launch tube is pivotably coupled to the upper jaw member and is used to urge the jaw members from a low-profile configuration to an open configuration. A needle assembly can be advanced through the launch tube across tissue received between the jaw members of the tissue manipulation assembly. Tissue anchors can be advanced through the needle assembly for securing received tissue. The tissue anchors can be positioned within a reloadable chamber of a control handle disposed outside the patient, then advanced through the needle assembly.

Abstract: An endoscopic tissue anchor deployment device includes a handle, an elongated shaft defining an internal lumen, and an end effector attached to the distal end of the elongated shaft. A tissue anchor catheter is removably inserted through the lumen of the elongated shaft, the catheter having a tissue anchor assembly that is deployable from its distal end. In some embodiments, the handle includes a pin and track assembly that define a series of handle actuation steps corresponding to deployment steps for the deployment device end effector and the tissue anchor catheter. In some embodiments, the handle includes a catheter stop member that prevents movement of the tissue anchor catheter under certain circumstances, and a handle stop member that prevents actuation of the handle under certain circumstances.

Abstract: An instrument for delivering a suture transfascially may include a handle, a shaft extending from the handle, and at least one needle that is moveable to an extended position beyond the end of the shaft. A suture may be delivered transfascially with the instrument. The instrument may include a suture catch associated with each needle for retaining and releasing a suture segment. A shield may be provided to shield the sharp end of each needle when it is moved to the extended position. A method of delivering a transfascial suture may include inserting an instrument into an abdominal cavity and deploying, from within the abdominal cavity, each needle through a soft tissue repair patch and then through at least part of the abdominal wall. A suture or suture segment may be advanced across the fascia with the at least one needle.

Abstract: A method for forming an artificial valve includes inserting a sheath having proximal and distal sections and a lumen extending therethrough orally into a body cavity; inserting an endoscope orally into a body cavity, the endoscope being slidably positioned within the sheath; holding tissue in a vicinity of a junction of a stomach and an esophagus where the artificial valve is to be formed, using a holding device extending from the sheath; penetrating through tissue of the esophagus and then through tissue of the stomach at an oral side of the junction of the stomach and the esophagus with a needle provided outside of the endoscope which is not mechanically connected to the holding device and which is moveable outside of the endoscope relative to the endoscope; and passing a binding member through the tissue of the esophagus and the tissue of the stomach using the needle.

Abstract: A suturing device includes a housing having an elongated tubular member extending from a distal end thereof. A head assembly is disposed at a distal end of the elongated tubular member and is configured to retain a portion of a suture therein. At least one arm member is positioned about the elongated tubular member. Each arm members includes a ferrule assembly disposed at a distal end thereof. Each ferrule assembly is positioned within a recess defined within the elongated tubular member and is configured to releasably retain a ferrule therein. Each ferrule is configured to retain a portion of the suture therein. Each arm member is rotatable to thereby rotate the ferrule assembly disposed thereon between a first position and a second position. The ferrule assembly extends at least partially radially outwardly from the recess in one of the first and second positions.

Abstract: An apparatus and method an apparatus and method for suturing, wherein said apparatus is a surgical instrument comprising a pair a cross members having securing means for pivotally securing the cross members to one another creating a first end, wherein the cross members second end comprises a locking device for locking the cross member and the first end comprises a clamping surface at a distal ends having at least two opposed curves forming a S-shaped sections having a outer smooth surface and a serrated inner surface assisting the suture process avoiding proximal slippage of suture material while tying a clamped structure.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot of the device can be inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot can carry suturing attachment cuffs with one end of the cuff adapted to receive a needle, while the other end receives suture. A portion of the foot and/or lumen of the shaft can receive a portion of the suture and can include friction reducing structure that aid with movement of the sutured during removal of the cuffs from within the penetration.

Abstract: A laparoscopic port closure device is described. The device allows for the deployment of a suture internally into an abdominal wall and the subsequent use of that deployed suture to effect a closing of the wound that was used for the port. The deployed suture may be used during the surgical procedure to effect a securing or anchoring of the device.

Abstract: A device for automatically providing needles to a sealing apparatus for sealing a puncture in an anatomical structure, the sealing apparatus including a needle insertion lumen and a needle pusher channel having a needle pusher disposed therein. The device may include a housing coupled to the sealing apparatus and a cartridge disposed in the housing. The cartridge has a slot and a plurality of needles disposed, therein. The needle slot is aligned with the needle insertion lumen and the needle pushing channel.

Abstract: A threading device assembly for use in plastic surgery that includes a threading rod and a removable suture assembly secured to the threading rod. The threading rod includes an elongated tube with first and second opposite ends and a reduced diameter portion defined therein, and a translucent light guide extending through the elongated tube. The light guide allows light to be transmitted through the material comprising the light guide from one end of the tube to the other. The removable suture assembly includes a cuff positioned in and at least partially around the reduced diameter portion of the elongated tube, and a suture secured to the cuff.

Abstract: Disclosed is an apparatus and method for facilitating the implantation and secure positioning of implantable medical devices within a subcutaneous pocket formed by a surgeon within the patient. Such apparatus and method are configured to address the above-described challenges of containing implantable medical devices within such subcutaneous pockets, and the spring-like leads or catheters that may be attached to them, during implantation.

Abstract: Devices, systems, methods and kits are provided for endoscopically accessing a body cavity and providing a directed pathway toward a target tissue within the cavity. The directed pathway is provided by a multi-catheter guiding system which is positioned in a desired configuration, generally directed toward the target tissue. Interventional devices may then be passed through the guiding system to the target tissue. Depending on the location of the target tissue and the desired angle of approach, the guiding system may be required to maintain one or more curves in one or more planes to properly direct the interventional devices. The multi-catheter guiding system of the present invention comprises an outer guiding catheter and a coaxially positioned inner guiding catheter, each of which independently form curvatures so that together the curves properly direct the interventional device.

Abstract: An assembly is described for repairing torn tendons by reattaching them to a bone, in particular although not exclusively for repairing a torn rotator cuff tendon, which allows for reduction of the gap between the tendon and the humerus by pushing the tendon onto its attachment site. Also described is a method of repairing a torn rotator cuff tendon by pushing it onto its attachment site and suturing through the humeral head.

Abstract: A graft tube is percutaneously placed inside the lumen of a vessel and attached to the lumen wall by loops of suture material. The plurality of short sutures are made in the shape of a loop with a sharp and a blunt end then forced into a plurality of first tunnels located in sections of circular cuffs that are attached to graft tube ends. The short sutures are pushed out the first tunnel by push rods and curve back to their original shape through the adjacent lumen wall and into a plurality of second tunnels where the short sutures are lodged.

Abstract: A suture locking device includes a carrier member, a locking assembly, a suture path, and an actuator assembly. The locking assembly includes a first locking member having an outer surface portion, and a second locking member having an inner surface portion. The suture path is receptive of a suture and defined at least partially through the first locking member, between the outer and inner surface portions, and at least partially through the carrier member. The actuator assembly is operable to move the first and second locking members together to lock the suture relative to the lock assembly.

Abstract: A suture locking device includes a suture locking assembly, a suture cutting member, and an actuator assembly. The actuator assembly includes a first actuator operable longitudinally to lock the suture with the suture locking assembly, and a second actuator operable laterally to concurrently cut the suture with the suture cutting member and disconnect the suture locking assembly from the suture locking device.

Abstract: A suture guide may include a base, a first tissue guard extending from the base, and two flanking posts affixed to the base on opposite sides of the tissue guard. The posts may extend from the base, and each of the posts may define a plurality of channels passing through its width. The channels may be so oriented that, for each post (a) the channels define suture needle guide paths in one or more planes, and (b) at least one channel passes through the first flanking post in a direction that is not parallel to a width axis W passing through the width of the first flanking post, so that it defines an oblique suture needle guide path. The first tissue guard may be connected to the base by a connector so adjustable as to control spacing between the posts and the first tissue guard.

Abstract: A surgical device for closure Atrial Septal Defect (ASD) with minimally invasive approach includes a head portion which is movable and includes a distal jaw that is distal relative to a person holding the surgical device, a guide rod which drives the distal jaw, and a plurality of first suture-guide channels attached to the distal jaw, and a body portion which is stationary and includes a cylindrical base, a proximal jaw attached to the cylindrical base, and a plurality of second suture-guide channels attached to the proximal jaw, in which the guide rod drives the distal jaw to pass a pericardium patch through a patient's ASD while the proximal end remains extracorporeal, and the first suture-guide channels and the second suture-guide channels guide a suture thread to suture the pericardium patch onto an ASD rim.

Abstract: A surgical device of suturing vascular vessels is described, as well as methods for suturing tissue employing the surgical device. In one form the device includes a distal member that contains a suture and needle engaging fitting. A needle is advanced through tissue adjacent the puncture wound and into the needle engaging fitting to draw lengths of suture material which can then be used to close the puncture wound. In another form the device includes a needle advanceable through tissue and into a needle capture element within a distal end of the surgical device to draw lengths of suture material which can then be used to close various puncture wounds. In still another form the device includes at least one needle advanceable to draw lengths of suture material to close various puncture wounds. A foot is pivotal between a non-deployed and a deployed position.

Abstract: A system for transdermal repair of soft tissue includes an instrument comprising a proximal actuator portion, a fixed needle having a lumen and extending distally from the proximal actuator portion, and a movable needle having a lumen and extending distally from the proximal actuator portion. The movable needle is movable axially between an advanced position and a retracted position relative to the proximal actuator portion. A suture needle is disposed within the lumen of one of the fixed and movable needles, and has a length of suture connected thereto. Needle graspers are disposed in the lumen of each needle, for securing the suture needle and assisting in the transfer of the suture needle from one needle to the other to complete a suture passing step.

Abstract: Medical suturing devices, systems, and methods will be useful for endoscopic (with or without access ports) or other surgeries in which access is limited, including ear, nose, and throat procedures. Articulation motions may be transferred from a handle to needle grasping jaws using an axial movement of a shaft that has axial stiffness (such as being stiff in compression) and lateral flexibility or an axial movement of a cable. An extension body (within which the shaft or cable moves) between the handle and jaws can be pre-bent or custom bent by the user. Portions of the devices may be disposable, replaceable, and/or reusable. A spring adjacent the clamp may open the clamp or impose a gripping force.

Abstract: Methods, instruments and systems are provided for separating opposite walls of the stomach by extragastric application of suction. Plication of the stomach can be performed between the separated walls after which the separate walls are brought back toward one another. In another aspect, methods, instruments, devices and systems are provided for reducing the effective volume of a stomach by performing one or more extragastric plications of the stomach.

Abstract: The surgical needle holder has two elongated arms that end in expansions in the form of scissor finger loops for introducing the fingers and correspondingly actuating both arms. The elongated arms are pivotally attached to each other and have pivotally mounted jaws at the ends of the elongated arms. Bevel gear mechanisms interface the elongated arms with the pivotally mounted jaws so that separating the finger loops separates the jaws, and bringing the finger loops together closes the jaws to grip a surgical needle. The needle holder has ratchet lock members extending towards each other between the elongated arms in order to lock the jaws on the surgical needle, similar to the locking of a hemostat. By applying this gear configuration, the motion of needles will be along any plane parallel to the longitudinal axle of the device while the surgeon's hand is in a neutral position.

Abstract: Medical devices, systems and related methods for delivering a plurality of tissue anchors. The medical devices generally comprise a needle and an over-the-needle suture lock, employed via inner and outer sheaths. The medical systems include a plurality of tissue anchors and at least one biodegradable or resorbable spacer member positioned between adjacent tissue anchors in conjunction with the medical devices.

Abstract: An active annuloplasty ring holder having a template that can be folded or pivoted to the side allowing the template to align longitudinally with the handle and enter the patient's chest through a small incision. The holder may include a mechanism to remotely detach sutures fastening the ring to the holder, thereby detaching the ring while avoiding the risk associated with introducing a scalpel into the operating field. A detachment mechanism may include a movable pin actuated by a pull wire that releases a plurality of holding sutures, or a hot wire, knives, or pull wire that severs the sutures. The holder may have a built-in light source for better visualization of the ring inside the heart. The holder may also have an optical means of visualizing the inside of the heart from the proximal end of the handle.

Abstract: A suturing instrument including multiple needle and suture assemblies that are at least partially disposed within the suturing instrument allows a surgeon to place multiple sutures intercorporally without having to remove the instrument from a surgical site and reload the instrument between placing each suture. The suturing instrument includes an elongate body member that includes a distal portion defining an opening. The suturing instrument further includes a first needle disposed within the opening, a second needle disposed within the opening, and a needle deployment mechanism disposed at least partially within the elongate body member and connectable sequentially to the first needle and the second needle.

Abstract: An apparatus for tissue repair includes first and second fixation members configured to secure tissue together, a flexible coupling member coupling the first and second fixation members, the flexible coupling member having two terminal ends, one of the two terminal ends terminating adjacent one of the first and second fixation members, the flexible coupling member slidably coupled to at least one of the first and second fixation members such that when the other of the two terminal ends of the flexible coupling member is pulled, a length of the flexible coupling member between the first and second fixation members is shortened, and a closed loop of flexible material, the flexible coupling member being slidably received through the closed loop of flexible material.

Abstract: In accordance with the present invention there is provided a suture trimmer, the suture trimmer comprising a shaft having a proximal end and a distal end and an axis therebetween, the shaft having a groove formed in the side thereof, the groove in communication with an opening formed in the side of the shaft, the opening disposed proximal the distal end. The suture trimmer further including a cutting member slidably disposed within the shaft, and a suture retainer slidably disposed within the shaft. Wherein the suture trimmer in accordance with the present invention may be additionally utilized to position knots formed within a suture loop prior to trimming the free end(s) of the suture loop.

Abstract: A method for suturing a patent foramen ovale (PFO) includes providing a suturing device, advancing the suturing device through the inferior vena cava, right atrium, and PFO such that a first foot of the device is positioned in the left atrium, deploying the first foot to a deployed position, orienting the suturing device such that a distal portion of tissue of the PFO is received in a pre-formed curve portion of a foot housing of the device, advancing the first needle through tissue and further into a first needle receptacle disposed on the first foot, and advancing at least one end of the length of suture through the tissue to suture the PFO.

Abstract: A device for tensioning suture which includes a cannulated tube that allows a suture to be fed through at least a portion of the tube. An adjustment device (for example, a wheel or a knob) is actuated to turn a threaded post on the end of the tube. A length of suture passes through at least a portion of the cannulated tube and is secured into a forked pin attached to the adjustment device. Turning the adjustment device draws against the suture, increasing therefore the tension on the suture. The suture tensioning device may be employed in conjunction with a tensiometer.

Abstract: A suture instrument includes a gripping portion that grips a plurality of tissue pieces by sandwiching them, and a suture needle that punctures and sutures the plurality of tissue pieces, the suture needle is supported so as to be able to move forwards or backwards relative to the gripping portion, and a direction of the forward or backward movement of the suture needle is set in a direction that intersects the tissue pieces gripped by the gripping portion.

Abstract: Instruments and techniques to pass a suture are presented. In one illustrative example, a suture passer includes a drill guide and is able to form a tunnel in a bone and pass a suture through the tunnel so formed.

Abstract: A suturing device and method allows a physician to remotely suture biological tissue. The device includes an elongate body, first and second arms operably connected to the elongated body, whereby each arm mounts an end portion of a suture, and first and second needles, each needle having a distal end and being mounted such that the distal end of the needle is movable to engage respective end portions of suture. The suturing apparatus further includes an actuator which drives the needles to engage the suture. The suturing apparatus further includes an occluding device operably connected to the elongate body such that the occluding device may be advanced from the distal end of the elongate body to temporarily occlude the incision to be sutured.

Abstract: A surgical introducer for an implant, such as a gastric band. The introducer has a shaft portion with a longitudinal axis extending through proximal and distal sides. A guide bore extends longitudinally through the shaft portion to extend the shaft to slide over an elongated guide member. A band-pulling member is disposed on the distal side and is configured to retain the implant in a loaded position on the shaft and to pull the implant in this position across an incision, such as across an abdominal wall, through an implantation site.

Abstract: The inventive sewing device for overcasting a mechanical twisted suture comprises a body (1) provided with a spiral needle (12) which is rotatable and translationally displaceable and is connected to a drive for rotating it, clamping jaws (6, 7) which are arranged on the distal end of the body for fixing the tissue parts to be sewed and provided with a unit for controlling the relative position thereof. The spiral needle (12) is designed in the form of an atraumatic or a hollow needle, is provided with a thread arranged therein, comprises at least two complete turns and is positioned in such a way that it is displaceable in a direction along the clamping jaws (6, 7) at a distance equal to or greater than the entire length of the spiral. The device comprises a nest (17) for catching the pointed end of the needle and/or the thread at the end of the suture and means for extracting the needle from the tissue.

Abstract: A spinal fixation assembly includes a pedicle rod and pedicle screws which secure the pedicle rod to the spine. Each pedicle screw includes a head configured to receive a portion of the pedicle rod, and a threaded portion extending from a first end of the head and configured to engage a vertebra. The pedicle rod is secured to the head by a fastener. The head includes a breakaway region that defines a location in which at least a first portion of the head can be easily separated from the remainder of the head upon application of sufficient force to the first portion. A minimally invasive method of implanting the spinal fixation assembly is disclosed.

Abstract: A cerclage device includes a base member, a cerclage member, and a drive member. The base member has a length sufficient to allow for manual holding by a user, an interior space extending from a distal end toward a proximal end, and a slot extending from the distal end toward the proximal end. The cerclage member has a long side with a proximal end and a distal end and a curvature in one direction about its long side at least at the distal end. The cerclage member allows for attaching a suture and fits within and is straightened by the base member within the interior space when in a retracted position. When the drive member is attached to the cerclage member movement of the engagement portion in the slot pushes and pulls the cerclage member to/from the straightened position from/to the extended curved position.

Abstract: Methods and systems for closing an opening or defect in tissue, closing a lumen or tubular structure, cinching or remodeling a cavity or repairing a valve preferably utilizing a purse string or elastic device. The preferred devices and methods are directed toward catheter-based percutaneous, transvascular techniques used to facilitate placement of the devices within lumens, such as blood vessels, or on or within the heart to perform structural defect repair, such as valvular or ventricular remodeling. In some methods, the catheter is positioned within the right ventricle, wherein the myocardial wall or left ventricle may be accessed through the septal wall to position a device configured to permit reshaping of the ventricle. The device may include a line or a plurality of anchors interconnected by a line. In one arrangement, the line is a coiled member.

Abstract: A suturing instrument having a dock at the end for receiving and securing a needle attached to a suture. The suturing instrument includes a cannulated handle attached to the proximal end of a cannulated shaft. The proximal end of a needle is removably received and securely received in the curved needle dock formed on the distal end of the shaft. The suture attached to the needle passes through the shaft and out the proximal end of the handle. Once the instrument is inserted into the body (usually through a cannula), the suture is retracted at the proximal end of the instrument handle, which draws the attached needle into the needle dock. The suture dock preferably has a compound curvature which prevents substantial rotation of the needle upon insertion.

Abstract: A knot placement device allows a physician to apply a knot for securing two or more suture ends extending from an incision in a vessel or organ of a patient relative to each other in order to seal an opening in the vessel or organ. The knot placement device has a handle and an elongate shaft and a push rod slidably inserted in said shaft. A knot is disposed in the distal end of the shaft. An actuator on the handle may be depressed to distally advance said push rod relative to said shaft and thereby distally advance said knot. The knot may include a knot body having an inner cavity and a plug sized to fit securely within the inner cavity. In use, the plug may be inserted into the inner cavity of the knot body to fixedly hold two or more suture ends between the knot body and the plug.

Abstract: A device for snaring cord-like objects is provided. The device comprises a hollow shaft having a pointed distal end, a rod having a pair of wires attached to its distal end, the wires being spring biased away from one another, and housing. The rod and wires are located in the lumen of the shaft in reciprocally movable relationship with each other. The housing is attached to the proximal ends of the shaft and the rod so as to allow controlled movement of the rod and wires relative to the shaft. One of the wire-like elements defines a hook-shaped configuration at its distal end. The device allows the wire-like elements to be selectively located within the distal end of the shaft or in a configuration where the wire-like elements extend outwardly from the distal end of the shaft in flaring relationship to one another.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot near a distal end of a shaft is inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot carries suturing attachment cuffs, and needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cross-section of the shaft within the tissue tract can be minimized by laterally deflecting the needles as they leave the shaft, while tapered depressions within the foot can guide the advancing needles into engagement with the cuffs. The cuffs lockingly engage the needles and can be withdrawn proximally along the needle paths and through the tissue tract so as to form a loop of suture across the puncture.

Abstract: Various exemplary methods and devices are provided for tensioning sutures. The methods and devices are particularly useful in surgical suturing applications in which it is desirable to maintain tension on a suture being delivered. In various embodiments, the device is incorporated into the handle of a suture device configured to deliver a suture to a surgical site. Other embodiments comprise a device that is separate from, but may be used in connection with, a suture device configured to deliver a suture to a surgical site. A suture locking device is also provided which enables the surgeon to ascertain when a desired amount of tension has been applied to a suture prior to affixing, knotting, or tying elements thereto.

Abstract: A medical tool includes an access tool and a dissecting obdurator that is placed within a lumen of the access tool. The dissecting obdurator comprises a body having a first edge, a second edge and a cross section, the cross section having a height dimension measured from the first edge to the second edge and a width dimension perpendicular to the height dimension, the height dimension is two or more times the width dimension. The tip of the dissecting obdurator is selectively flexible and coupled to a distal end of the body, the selectively flexible tip being more flexible bending in the axis of the width dimension than bending in the axis of the height dimension.

Abstract: A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to flex relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. Tissue suturing and suture securing instruments are provided each having a sufficiently flexible shaft locatable through the accessory tube.

Abstract: A surgical instrument having the dual functions of gripping a suture needle and cutting a suture. The instrument performs one function when the handles are pivoted together and the other function when the handles are pivoted apart. The instrument also provides for a precise suture tail length when the suture is cut.

Abstract: A surgical device for suturing vascular vessels is described, as well as methods for suturing tissue employing the surgical device. The device includes a distal member for insertion into a vascular vessel puncture wound. The distal member contains a suture and needle engaging fitting. At least one needle is advanced through tissue adjacent the puncture wound and into the needle engaging fitting to draw lengths of suture material which can then be used to close the puncture wound.